Solitaire支架机械取栓治疗急性颅内大动脉闭塞效果观察

Effect of mechanical thrombectomy with Solitaire stent in the treatment of acute intracranial large artery occlusion

目的探讨Solitaire支架机械取栓治疗急性颅内大动脉闭塞临床效果及安全性。方法回顾分析我院采用Solitaire AB型支架机械取栓治疗急性颅内大动脉闭塞的15例患者的临床资料（均超过静脉溶栓3．5h的时间窗），其中单纯大脑中动脉闭塞11例，颈内动脉颅内段闭塞2例，椎基底动脉闭塞1例，大脑前动脉闭塞1例。分析闭塞血管再通情况、手术并发症，对比患者术前及出院时NIHSS评分。结果15例中14例闭塞血管完全再通，1例部分再通。2例取栓后M2段，1例椎动脉开口狭窄，同期给予支架成形术。死亡2例。13例存活患者NIHSS评分从入院时的（22．85±4．75）分至出院时（4．39±3．67）分，差异有统计学意义（t=2．752，P〈0．01）。结论Solitaire AB支架取栓治疗急性颅内大动脉闭塞再通率高，并发症少，预后较好。对于超过静脉或动脉溶栓传统安全时间窗的患者，经综合评价后，可在8h内考虑机械取栓。

Objective To evaluate the safety and effectiveness of mechanical thrombectomy with Solitaire AB stent in the treatment of large intracrauial artery occlusions. Methods The calinical data of 15 patients with acute stroke（ more than 3.5 h intravenous thrombolysis time window） who were carried out arterial embolectomy with Solitaire AB stent in the No. 264th Hospital of the Chinese People＇s Liberation Army were retrospective analyzed. There were 11 cases of middle cerebral artery（MCA） , 2 cases of internal carotid artery （ICA） , 1 case of vertebral artery（VA） pluse basilar artery（BA） , and 1 case of anterior artery（AA） . The recanalization occluded situation and surgical complications were analyzed, NIHSS score of preoperatively and at discharge were compared. Results In 15 cases, there were 14 cases of totally recanalization, 1 case of partial recanalization. Two case with MCA stenosis and 1 ease with VA stenosis after the recanalization were accepted stent angioplasty, 2 csase died. NIHSS score of 13 cases survival patients increased from （22. 85±4. 75） scores on admission to （4. 39 ± 3.67） scores out of hospital, and the difference was statistically sinificant （t = 2. 752, P 〈0. 01） . Conclusion The mechanical thrombectomy with Solitaire AB stent can get high recanalization rate, fewer complications and good clinical outcome on patients with large intracranial artery occlusions. For more than venous or arterial thrombolysis time window, the mechanical thrombectomy can be considered within the 8 h after comprehensive evaluation.